RT Journal Article
SR Electronic
T1 Outcomes and inequalities in diabetes from 2004/2005 to 2011/2012: English longitudinal study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e1
OP e9
DO 10.3399/bjgp16X688381
VO 67
IS 654
A1 Fleetcroft, Robert
A1 Asaria, Miqdad
A1 Ali, Shehzad
A1 Cookson, Richard
YR 2017
UL http://bjgp.org/content/67/654/e1.abstract
AB Background Outcomes of diabetes care are unequal and the NHS has a duty to consider reducing inequality in healthcare outcomes.Aim To quantify trends in socioeconomic inequality and diabetes outcomes.Design and setting Whole-population longitudinal study of 32 482 neighbourhoods (Lower Layer Super Output Areas [LSOAs]) in England between 2004/2005 and 2011/2012.Method Slope indices of inequality (SIIs) between neighbourhoods of great and little deprivation were measured annually for: glycated haemoglobin control in people with diabetes; emergency hospitalisation for diabetes; and amenable mortality from diabetes.Results From 2004/2005 to 2011/2012 glycaemic control improved in all social groups, regardless of deprivation level, although inequality was unchanged as measured by the SII (0.04, 95% confidence interval [CI] = −0.43 to 0.52). Diabetes-related amenable mortality improved in all social groups, but decreased at a faster rate in neighbourhoods of greater deprivation. Inequality in diabetes-related amenable mortality improved, with the SII falling by 2.68 (95% CI = 1.93 to 3.43), resulting in 594 (95% CI = 420 to 767) fewer deaths. In contrast, emergency hospitalisations for diabetes increased in all social groups, with faster growth in neighbourhoods of greater deprivation. The socioeconomic gradient increased with the SII widening by 19.59 admissions for diabetes per 100 000 (95% CI = 16.00 to 23.17), resulting in an increase of 5991 (95% CI = 5084 to 6899) excess admissions associated with socioeconomic inequality during the study period.Conclusion In diabetes, mortality declined faster, but emergency hospitalisation grew faster in more deprived neighbourhoods. Unequal growth in emergency hospitalisation for diabetes is likely to be partly due to increased diabetes prevalence and patients living longer, but may also be due to overuse of glycaemic control medication.